Asking hard questions about health equity research

What does it mean to do health equity research? This episode look at a recent STAT news article and asks some hard questions about health equity research. Many of you who listen to this show are involved in health equity work in one way or another. And Health Communication Partners is a health equity focused […]
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What does it mean to do health equity research?  This episode look at a recent STAT news article and asks some hard questions about health equity research.

Many of you who listen to this show are involved in health equity work in one way or another. And Health Communication Partners is a health equity focused consultancy. Recently an article in STAT news invited all of us to ask some hard questions about what it means to do health equity research. And that’s what this episode is about.

Hi everybody. I'm Dr. Anne Marie Liebel. This is 10 Minutes to Better Patient Communication from Health Communication Partners, an independent health-equity focused education and communication consultancy. If your organization needs expert help on any topic in this series, visit healthcommunicationpartners.com.

Today's episode sponsored by Maven Roth group. For many people, the hardships and changes resulting from the pandemic have shifted priorities. Because of this, Maven Roth is helping organizations evolve their messaging to better meet their audiences' needs. Maven Roth can refresh your marketing to reflect today's changes. Visit mavenroth.com.

So there are many things to be positive about in how many people and how much attention they’re giving to Health Equity work right now. It is certainly overdue. But along with this attention is some, I think, necessary discussion about some of the challenges, the complications, obstacles, and opportunities in working for equity. Recently STAT news published an article called “Health equity tourists:” How white scholars are colonizing research on health disparities. Links in the show notes of course. It’s getting some social media attention and they posed some hard questions about health equity research, such as, “who can and should be doing this work?” Among other examples, the authors “documented dozens of cases where white researchers are building on the work of or picking the brains of, Black and brown researchers without citing them or offering to include them on grants or as co-authors.”

As you know I’m coming from a history, right, in the education world. Language, literacy, education. And there, there is a knowledge base, decades deep on what commitments to equity can look like. And the challenges of equity-oriented work in research, theory, practice, policy. So I’m going to go back to a couple things that I've done recently and kind of sit with you for a moment and ask some more pointed questions, so that you can be aware of some of the challenges of equity research that I know about from my experiences in the education sector.

Why am I doing this, though? Why ask hard questions? It’s because this kind of interrogation is part of the traditions that I come from. It’s part of what it means to me to take what I call a critical health stance. I believe that any equity-oriented approach to health communication, health literacy, and patient education–research, theory, practice, policy– it necessarily involves terminology, discourses, and practices that are themselves grounded in equity and justice. And we can find out if that grounding is there by starting to ask some hard questions.

Our most recent episode was about collaboration, specifically collaboration around Health Equity, right? This STAT news article mentions that collaboration is a necessary condition of equity-oriented work, including research. And they’re right! Collaboration I think is also the first place you can start acting on your commitment to health equity. Because whom you choose to collaborate with, and who you choose to cite, can be an equity issue. In the collaborating  episode, I said people you got to find those who are already doing the work. Because yes in some ways what we’re going through with this pandemic is new, but in many ways not so much.

People and organizations have been addressing racism, discrimination, and inequities on individual and systems levels for decades. So I encouraged you in this most recent episode to ask, “Who's been in the trenches? Who’s been doing the work? Who’s been on the path since way back?” and I said: find them, listen to them, learn from them, and uplift them.

So I want to put a finer point on this. If you’re a researcher that also means citing and inviting them. I think that’s the point–one of the points–the STAT news article was trying to make. But I’m suggesting this is more than doing your usual homework.

The question I want to pose here is asking, who did work like this? Who did work adjacent to this? Even who did work in this spirit of this, before me? And really being committed to finding them and citing them, because they’re there. It means being willing to drop the notion that’s front of mind for many researchers about being the first, the first on the scene, right? So dropping that impulse is contrary to how many of us are trained and rewarded, which is itself a systematic problem. And the STAT article also addresses that.

Okay next, I want to talk about earlier podcast episode that I did on the definition of health equity as an important and consequential concern. In that episode, I cited a 2020 paper by Adam Wildjan and Keith Denny that was in the Journal of Public Health Ethics. And the authors state, “Since 1984, the idea of health equity has proliferated throughout public health discourse.” And they’re concerned about what the term means, calling it an “empty signifier.” They explain, “widespread invocation of health equity has been associated with a considerable emptying of its semantic and political content.”

Now I’m also concerned with the meaning of health equity, because a way a term is understood has real consequences in research, right? So for this, I’m going to go to some questions I've posed in a recent health literacy keynote that I gave. Because professionals in medicine and public health who care about health literacy are very aware of the power of terms and phrases. So I thought this would be something I could share with you as well.

I’m asking you think about what equity means in practice as well as research and policy. But how do you do that? I want to give you some concrete steps, some questions you can ask.

If you’re working with a text –whether you’re reading or writing one, any kind of document–look for literally how is health equity defined. In a journal article, there’s always that definition gets dropped in the first couple paragraphs. I’m going to ask you to pay attention to that.

Also, the other ways health equity gets defined implicitly through the rest of the paper. What are the authors trying to say it means? What are you trying to say it means on the ground? What’s being taken as a stand-in for health equity? Because at some point health equity gets operationalized. So pay attention to that.

How far of a leap is it from the definition to how it’s being operationalized? What are you being asked to assume or expect, in order for that leap to work, right? What are you being expected to ignore, or kind of forget about or sideline, in order for that to work? For those basic assumptions to hold?

Another question. Any project or initiative or research that purports to address [health] equity must have at least implied if not explicitly stated within it: what are the assumed causes of health inequalities? These need to be looked at too.

I think many of us here could say we know what some of the root causes are of health inequalities. And these are upstream and these are systematic. But, do papers, initiatives, programs that you’re involved with seek to address these upstream causes? What are the arguments being made for the project’s or paper’s proposed solutions?

This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music by Joe Liebel. I'm Dr. Anne Marie Liebel.

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